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Wednesday, May 21, 2008

Avian influenza has spread and, while it has not reached pandemic proportions, constant vigilance is still crucial.

Avian flu is in the news so much nowadays that some of us may have become desensitised to the urgency of the matter.

When news about avian flu first broke in 1997, there was much concern when it revealed that the virus, having transmitted from chickens to humans, had infected 18 people and killed six. Then, things quieted down for a few years, until 2003 when avian flu made an appearance again and never went away.A health worker injecting a chicken with the bird flu vaccine in a poultry farm in China. The H5N1 (virus) may never become pandemic but, if it does, the catastrophic situation could be more than we can even imagine.

According to Prof Malik Peiris, the avian flu problem has been progressively increasing. Peiris is the virologist who discovered the aetiological agent that causes Severe Acute Respiratory Syndrome (SARS), and has been involved with avian flu research. He is based in Hong Kong, but was in Kuala Lumpur recently to receive the Mahathir Science Award 2007, Malaysia’s most prestigious science award named in honour of former prime minister Tun Dr Mahathir Mohamad.

During the SARS outbreak, Peiris led a team of researchers from the University of Hong Kong and Queen Mary’s Hospital who managed to identify the SARS coronavirus within weeks. That breakthrough, along with other measures, led to the successful control and containment of the outbreak.

After the avian flu outbreak in 1997, Peiris subsequently became more interested in avian and animal influenza viruses and their danger to humans.

“If you look at the geographical area that is affected, it is now bigger than it was two or three years ago,” said Peiris. “So if you look at that scale, at the poultry level, it is increasing. It is certainly not going to disappear. This is going to be entrenched, and we are not going to be able to get rid of it in the short term.”

Fortunately for us, the efficiency of the virus infecting humans is still very low. Most of the time, people who are exposed to the virus are not infected. But Peiris identifies two levels to the problem. First, the huge poultry industry would mean that people’s livelihood, the country’s economy and human health would be affected. Second, the occasional transmission of the virus from poultry to humans, where the real danger is, if the transmissions are not monitored and controlled, and the virus is allowed to adapt and transfer between humans.

“There are people who say, well, this virus has been here for 10 years, and it has not really done this, so it won’t happen,” said Peiris. “I think that is extremely dangerous. That was exactly the same situation with SARS. That virus was also probably in the animal reservoir for quite a long time.”Prof Malik Peiris: ‘We really have to take it (bird flu) seriously, and take measures to see what can be done.’

But Peiris pointed out that this doesn’t mean we should start panicking, nor should we be complacent about it.

“On a risk-assessment basis, the H5N1 (virus) may never become pandemic,” said Peiris. “But the point is, if it does, the catastrophic situation could be more than we can even imagine. It definitely could be much worse than any of the past pandemics. We really have to take it seriously, and take measures to see what can be done.”

Mutation

While there are claims that the virus is two mutations away from human-to-human transmission, and that it has learnt to infect humans more easily, Peiris dismissed these as “simplistic”.

“It obviously requires a lot of adaptations, not just one or two,” Peiris explained. “A number of studies have shown that mixing the genes alone doesn’t do it. It requires a multi-step process. That’s probably why it hasn’t happened so far. But I think these rare events do happen, and we’d be very stupid not to take precautions.”

Peiris warned that the problem is currently “grossly underestimated”. In countries where the virus is endemic, he said, much more poultry carry the virus than people imagine. Poultry enter the markets and are slaughtered, so it doesn’t seem as though they are dying from the virus. But the virus continues to circulate as farmers bring their cages to the markets, leave the poultry there, and return to their farms with the cages, unaware that those cages may have come into contact with the virus.

“Once the virus gets in a market, it remains there almost forever,” said Peiris.

He said countries such as Malaysia, Japan, North Korea and India have been successful in detecting the virus early and eradicating it, demonstrating the need to be alert at all times.

Even during the lull between 1997 and 2003, virologists and researchers continued their surveillance and published papers on their findings, all the while aware that the virus was still lurking somewhere and was adapting.

Defence

While the capacity for producing vaccines has increased, Peiris said the real challenge is in creating a vaccine that would protect against more than one strain of the H5 virus which is now diverse. The fact that we do not know which strain will become pandemic means there needs to be broad protection. Peiris said the newer vaccines that have come to clinical trials look promising, but there is also the problem of trying to produce enough in an emergency.

This raises some tricky issues. We could wait for a pandemic before producing the vaccine, but chances are there would not be enough time because it takes months to scale up production. The second option, said Peiris, is to stockpile the vaccine in advance, but money could be wasted if a pandemic never happens.

This would mean that an ideal situation where one could walk into a store and purchase the vaccine in an emergency would never be viable.

“You can’t have a vaccine that is not regularly used sitting in the stores,” said Peiris. “For the next five years, it might not be used, and it will be out of date. I think the real possibility is to stockpile it in bulk at governmental level. So if the emergency comes, it can be quickly distributed.”

Asked if there is a beacon of light in this seemingly hopeless situation, Peiris pointed to how SARS was successfully controlled, and that it was a great achievement of global collaboration.

“I think the control of SARS was probably one of the greatest triumphs for global public health,” he said. “So things can be done, for sure. But we can’t sit back and assume that things will happen. It is actually planning, intervention, collaboration and all these things that made it happen.”

Tuesday, May 6, 2008

Is lack of sleep bad for the brain?

I need sleep

Is lack of sleep bad for the brain? Both nightshift work and chronic sleep deprivation increasingly are implicated in mental and cognitive problems.

AIzheimer's risk: Abnormal insulin levels (common in shift workers and sleep-deprived people) might increase the risk for certain neurodegenerative disorders, such as Alzheimer's disease, scientists at the University of Washington have found.Normally, insulin acts on the brain to promote learning and memory. Insulin resistance, however, might cause inflammation inthe brain, a key process in the development of Alzheimer's.

learning: Proper alignment between sleep times and internal circadian time is crucial for optimal cognitive performance.

And numerous recent studies show learning is enhanced if it's followed followed by restorative sleep.

In other words, students who pull all-nighters studying for an exam are doing themselves more harm than good.

Mood: Even moderate changes in sleep times can have a big effect on mood. Diane Boivin of the Centre for Study and Treatment of Circadian Rhythms at Douglas Mental Health University Institute in Montreal published research last year in the journal Sleep showing that serotonin levels - a key sub-stance for mood stability - are lower in shift workers than day workers.

Other studies have found that exposure to bright light in the morning can lift the moods of people with depression, and that prescribed periods of sleep deprivation can interrupt a bout of depression.

Bipolar disorder: Flawed circadian rhythms might be to blame for bipolar disorder. In a study published last year in the Proceedings of the National Academy of Sciences, scientists from the University of Texas Southwestern Medical Center identified a gene that, if disrnpted, causes mice to behave as if they have bipolar disorder. Correcting the geue mutation could lead to a therapy for the illness, the scientists said.

Does circumcision help protect a man from developing a sexually transmitted disease ?

Circumcision against STDs?

DOES circumcision help protect a man from developing a sexually transmitted disease (STD)?

A study analysed data on 499 men; 201 had been circumcised before age three. By age 32, 117 of the men reported that they'd had a sexually transmitted infection, most often genital warts, chlamydia or genital herpes. The infection rate was virtually the same - about 23%; - whether men had or had not been circumcised as a child.

Who may be affected? Men. In the United States, about 65% of all boy babies are circumcised, meaning the skin that covers the tip of the penis is surgically removed. The decision often is based on cultural or religious views or personal preference rather than medical necessity.

Caveats: Data on STDs came from questionnaires completed by the men. The authors wrote that other research has provided "compelling evidence" that circumcision lowers the risk of men's contracting H1V infectionm through sex with women.

BABIES born before they've been in the womb 37 weeks face a higher risk of complications very early in life

Being premature

BABIES born before they've been in the womb 37 weeks face a higher risk of complications very early in life. as they grow up, though, do people born prematurely continue to exhibit differences from those carried full-term?

A study analysed data on more than a million people born in Norway during a 20-year period; about 5% were premature births.

The more premature the infants had been, the more likely they were to have died before turning one year old. Survival rates improved through late childhood but remained lower, by comparison, for those born prematurely.

As teens and young adults, those who'd been premature were more likely to have attained less than a high school education and less likely to have gone to college than those who'd been full-term babies.

Adults wbo'd been premature infants also were less likely to have had children of their own. And women who'd been premature were more likely, once pregnant, to have given birth prematurely than were women born at full term; prematurity did not affect men's chances of fathering a premature infant.

Who may be affected? People born prematurely. In the United States, more than 12% of babies are premature, a rate that has been steadily increasing over the past two decades.

Caveats: The cause of the premature births was not indicated. The findings might be different for babies born today, given medical and technological advances in the 40 years since the study began.

The findings, which appeared in the most recent issue of Clinical Cancer Research, reaffirm that patients should inform their doctors about any herbal or hormonal dietary supplements they are taking or considering taking. The researchers also recommend that documentation of supplement usage become part of routine health assessments for all patients, particularly cancer patients.

"Physicians need to ask their patients not only about the prescription drugs they may be taking, but - perhaps even moreimportantly - about the over-the-counter drugs and supplements, which may have a profound impact on certain health conditions," said Dr Claus Roehrberu, chairman of urology at UT Southwestern and one of the study's authors.

The researchers began their investigation when two patients being seen by UT Southwestern doctors developed aggressive prostate cancer within months of starting daily consumption of the same dietary supplement. Both men purchased the same product. one to develop stronger muscles and enhance sexual performance, the other to gain muscle.

Dr Roehrborn, Dr Shahmkh Shariat, a resident in urology and the study's lead author, and their colleagues analysed the supplement, which is not named in the study. They found that the product's label listed ingredients that were not present, misrepreser/ted the concentrations of the ingredi- ents present and failed to list all the steroid hormones contained in the product.

Hormone analysis revealed that the supplement contained testosterone and estradiol, a sex hotmone. Researchers then tested the effect of the product on human prostate cancer-cell lines. The product proved to be a more potent stimulator of cancercell growth than testosterone, Additionally, attempts to stop the cancer-cell growth with increasing concentrations of the anti -cancer drug bicalutamide proved to be futile.

"Bicalutamide is an oral nonsteroidal anti-androgen used to treat prostate cancer," Dr Shariat said. "The fact that this supplement caused the drug to be less effective is very troubling."

Based on the clinical data and cell culture experiments, the researchers filed an adverse event report with the Food and Drug Administration. The government agency in turn issued a warning letter to the manufacturers, which led to the removal of the product from the market.

"Unlike prescription and over-the-counter drugs, the law does not require nutritional supplements to undergo pre-marketapproval for safety and efficacy," Dr Shariat said. "The current FDA regulatory system provides little oversight or assurances that dietary supplements will have predictable pharmacological effects or even that product I`abels provide accurate information for consumers."

The researchers SaY expanded research is needed co define the mechanism, safety ,and efficacy of common herbal and hormone dietary supplementS.

"For most supplements efficacy is not established ifl randomised, controlled trials, wlaat is worse, safety is often equally poorly established," said Dr Roehthorn, who directs the Sarah M. and Charles E. Seay Center for Pediatric Urology.

An estimated 42% to 69% of US adults use dietary supplements, at an estimated out-of-pocket expenditure of about US$34.4bil(RMl13.5bil), according to published reports cited in the study.

Individuals often use supplements because they believe these natural products are safe and drugfree. The sale of androgenicsteroids is exponentially increasing. In 2004, US expenditures on testosterone supplements were estimated to be US$425mil(RM1,402.Smil),

"Given that testosterone supplements are in high demand, there is significant concern that supplements, in addition to the one we evaluated, may pose an urgent human health risk," Dr Shariat said,

Sunday, May 4, 2008

Programme uses acupuncture to treat addiction - Needle that addiction

As New Age music fills the room, 19 men and women settle into four rows of plastic chairs. They swab their ears with alcohol towelettes and sit quietly.

Slowly, another man and a woman move among the rows. With quiet precision, they insert five sharp needles into each oftbe people's ears. Nobody flinches when the needles hit the flesh. In fact, some of the men and women have tiny grins on theirfaces.

This is addiction treatment, Montgomery County, Maryland, style. These people are participating in a pilot programme that uses acupuncture, an ancient Chinese medical practice, to help treat addiction.

More than a dozen people a day are volunteering to be stuck with needles as part of the county's acudetux programme, which began in February.

Karlys Wright, 37, was one of the first to arrive for the early morning acudetox session. She said she almost didn't give acupuncture a try because she doesn't like needles. But in a brief time, she has become a fan of the New Age treatment.

In the fall, Montgomery County Council member Duchy Trachtenberg persuaded her colleagues to spend US$20,000 (RM66,000) on a pilot programme that would incorporate acupuncture into treatments for drug addiction. Acupuncture is used as a strategy tocalm and relax patients before they take part in other treatments, such as group therapy.

"It's cutting edge," she said, "there's no question about that."

The Chinese have used acupunctore for centuries to treat a variety of ailments, including chronic plan and infertility. Its use as a strategy for treating addiction is gaining popularity in communities across the country, Trachtenberg said. Prngrammes are in place from California to Virginia to Florida.

The hard science behind acupuncture remains elusive. But those who run treatment programs say that, anecdotally, they see a marked change in the attitude of patients, who are calmer and more receptive to therapy.

The Fairfax County, Virginia, programme has been in place since the late 1990s. Although the county has not done official research on the method, Larry Peacock, director of the Faiffax Detoxification Center, said patients say acupuncture has helped reduce their alcohol and drag cravings and made it easier for them to sleep.

"Qne of the things that we did and have seen is a reduction of incidents with clients arguing; the anxiousness and agitation levels are lowered," Peacock said.

Larry Gamble, manager of outpatient addiction services, behavioural health and crisis services for the Montgomery Department of Health and Human Services, says he initially had doubts but they evaporated after taking part in a session.

"We've been amazed at how some of the dients have been able to slow themselves down and be more focused and be more open when they go into individual group therapy," he said. "Clients say they sleep better and feel less stressed."

Researchers at the National Institutes of Health's National Center for Complementary and Alternative Medicine are conducting more than 100 studies examining the effect of acupuncture on a range of problems, including autism, hot flashes and obesity.

But there is still debate in the scientific community over acupunclure's 6ffectiveness as a treatment for some medical conditions, including drug addiction.

Acupuncture isn't-the only alternative therapy officials have used to help people in Montgomery's drug treatment programme. About four years ago, Gamble said, they also began offering meditation and yoga.

Linda Washington, a psychiatric nurse and licensed psychotherapist, said patients who did acupuncture seemed to make quicker progress through therapy than those who did not.

With music playing in the background, Washington and Dave Wurzel, a certified trainer with the National Acupuncture Detoxffication Association, slowly made their way around the room, In this particular form of acupuncture, auricular acupuncture, five needles are inserted in each of the clients' ears. At first glance, the needles look like straight pins, but they are thinner and more flexible.

Once the two completed their rounds, they dimmed the lights. After a while, the only sound was of music mixed with deep rhythmic breathing, The tranquility was broken only briefly when someone began to snore loudly.

The clients, some of whom are in detoxiflcation treatment by court order or are referred by social workers, are a mix of races, sexes and ages. Some are homeless: others are mentally ill. Some are hard-core drug users addicted to hemin or cocaine, Gamble said.

Trachtenberg is optimistic that the one-year pilot will show positive results. She notes that larger counties, including Miami-Dade, Florida, have had success with the approach. In Miami-Dade, about 85% of the people in county treatment programmes do acupuncture.

"Medicine has really changed in this county, and many people really are much more comfortable with an integrated approach to care," she said, "More and more Americans are using alternative therapies,"

Wurzel, who trained the staff in Montgomery and is proprietor of the Chi Farm, said acupuncture is not a cure-all in itself but is designed to complement other types of addiction treatment,

Oliver Oree, 51, recently retomed for his second session under the needle. He doesn't quite get the science behind the needles, but that's just fine - he's willing to take it on faith. Said Oree: "I don't know what it is or how it works, but I feel like a better person."

Heath Ledger and Brokebock Mountain are names that ring a hell for many people

His legacyOne to be remembered: Father of Angiogenesis, Dr Judah Folkman -1933 to 2008.

HEATH Ledger and Brokebock Mountain are names that ring a hell for many people who have been following the recent entertainment news.

Few would recognise, much less have heard of, Dr Judah Folkman.

Though both men died in the same month (January 2008) each event received a different level of publicity.

Quite often, for people who work hard behind the scenes, it takes a substantial amount of effort to be reeognised. Dr Folkman, a cancer treatment revolutionist, was one that contributed his greatest to mankind but remains unfamiliar to the majority of the six billion people on earth.

Dr Folkman was the founder and director of the vascular biology programme at the Children's Hospital in Boston and a professor of paediattic surgery and cell biology at Harvard Medical School, also in Boston.

He was very passionate about his work and many have said they were not surprised to hear that Folkman, 74, was working till the very end. He collapsed at the Denver International Airport on his way to a speaking engagement in Vancouver.

His departure is indeed a great lost not only to his family, but the world at large. Dr Folkman is sur-vived by his wife, Paula, with whom he lived in Brookline, Massachusetts, two daughters and a granddaughter (Hannah).

The early days Born in Cleveland in 1933, Moses judah Folkman was the son of a rabbi. He had a brother and a sister and, as a boy, started making house calls to the sick with his father. He began his medical career in high school in Bexley, Ohio, volunteering in a hospital laboratory at Ohio State University. This early calling led Dr Folkman to Ohio State University, where, by the end of his freshman year, he was performing surgery on dogs under the mentorship of Dr Robert Zollinger, then president of the American College of Surgeons.The young Dr Folkman even designed a device to cool the liver during surgery without causing organ damage and then, he became coauthor on his first academic paper.With this extraordinary achievement, he was accepted into Harvard Medical School at the age of 19. After graduating in 1957, Dr Folkman began his surgical residency at the Massachusetts General Hospital and served as chief resi-dent in surgery from 1964 to 1965.

Discovery of Angiogenesis TheoryIn the midst of his residency at Massachusetts General Hospital, Dr Folkman was suddenly drafted into the Navy, assigned to do research on artificial blood at a facility in Bethesda, Maryland.The assigned work was finished far earlier than expected, so Dr Folkman and a colleague, pathologist Fred Becker, had free time in the laboratory and decided to study tumour cells growiug in a special apparatus. Dr Folkman saw something unusual when their black melanoma cells only grew briefly. All the little tumours were exactlythe same size. He knew that this wasn't natural and something must have halted their growth at a maximum size. That initial observation led to years of experimenting, thinking, arguing, and exploring until he concluded that the tumours had all stopped growing because they couldn't get enough blood. As this research continued, Dr Folkman returned to his internship at Massachusetts General Hospital, and then began work at Boston City Hospital as a young surgeon. In 1967, when he was only 34, Dr Folkman was recruited to become chief of surgery at Children's Hospital. While serving as chief of surgery, he continued pursuing his research, believing that "angiogenesis" was the factor that made tumours grows larger.

A lonely voice and a breakthroughIn the 1970s, Dr Folkman's team applied for their first grant based on the hypothesis of angiogenesis and its role in tumour development and growth. However, the reviewers at the National Cancer Institute turned them down. Dr Folkman never gave up pursuing his research. In subsequent years, as a result of a huge number of experiments, failures, breakthroughs, and insights, Dr Folkman and his colleagues were able to prove four major points: 1. Tumours do require blood to grow; 2. Turnouts do recruit the blood vessel systems that bring in fresh blood; 3. The recruiting mechanism involves hormone-like growth factors emitted by the tumour; 4. The body makes natural factors that can shut down abnormal blood vessel growth; a phenomenon that Dr Folkman named "anti-angiogenesis". The journey of discovering a new agent which could stop angiogenesis was not smooth sailing. The media troubled him with over-whelming publicity on his research. His innovative ideas drew attention, especially from reporters covering science and medicine. As a result, news stories often proclaimed his successes, and desperate patients quickly besieged their doctors seeking a new "cure" that didn't exist. The publicity problem became most extreme in May of 1998, when a New York Times reporter quoted Nobel-winning biologist James Watson as saying "Judah's going to cure cancer in two years." This placed tremendous pressure on Dr Folkman and his colleagues, especially when some of their antiangiogenic agents failed to deliver the exoected results.The turning point came about five years ago, in 2003, when San Francisco's Geneutech lnc reported success with a drug they ca]led bevacizumab, an anti-angiogenesis agent which blocked the action of the stimulators of blood vessel growth.Clinical trials showed that infusing regular doses of bevacizumab actually extended the lives of patients with colorectal cancer.Since then, bevacizumab has been approved worldwide for use ir such patients. It has also been approved for breast cancer patients in the U5 and Europe, and is showing promising results against various solid tumour cancers.Dr Folkman's tenacity and determination culminated it the breakthrough discovery that has changed the entire landscape of solid tumour cancer treatments. His efforts have helped thousand', afflicted with cancer and remain one of the most promising approaches in future cancer treatment development and management. His passion for results and his determination in pursuing the seemingly impossible have touched the lives of many colleagues and patients alike and earned the highest level of respect and reverence. "A bright light has dimmed at Children's Hospital and for the cancer-research world. May that light shine again and guide the way as others are inspired to continue Dr. Folkman's vision and research for a cure for cancer. This is truly what he would want," adds Jo-Ann Rose RN. "To honour his memory we should all follow his example - pursue your dreams, never give up. and believe in yourself. May his memory be eternal."

3,000 Malaysians are diagnosed with endstage kidney failure and have to go for dialysis

Living with dialysis

Every year, more than 3,000 Malaysians are diagnosed with endstage kidney failure and have to go for dialysis. Today, over 15,0O0 Malaysians are on dialysis. This is expected to reach 20,000 by 2010.

LIFE is not easy for wheel-chair bound Sellamah Sinakanu, 68, who has to depend on people like her grandson to take time off work to take her to the dialysis centre. She has end-stage kidney failure.

"I nearly could not get dialysis because my 8S-year-old husband is not working and we've no money. I'm able to live longer now thanks to the support from National Kidney Fouhdation of Malaysia (NKF)," Sellamah said.

Dialysis has now givell her a second chance to live, as she would have died without it.

Lira Ah Chai, 58, was forced to give up his 13-year-old son to his brother when his wife passed away. Six months later, Lira, diagnosed with end-stage kidney disease, had to go for dialysis in order to survive, With no job, he has to depend on NKF for dialysis,

"Dialysis keeps me alive and well so I can continue to lead a normal life, There are days when I feel very sad but my friends will tell me to look on the bright side as my new home is NKF and everyone here is kind to me," says Lim with a smile.

Today with rtew friends, he has much to look forward to. He hopes to meet his son one day.

It is estimated that the number of dialysis patients worldwide will increase by 7% per annum.

This may seem alarming but it is living with dialysis that is really devastating. When the shock of the diagnosis subsides, the patient has to adapt to a different way of life.

With impending death constantly on the mind, he or she has to depend on a machine to stay alive, thinking that any day, this too will not be of any use. Although among friends and family, the patient will still feel isolated and a burden tothe family. Depression will be a constant companion.

Apart from emotional upheaval, the patient has to go through physical agony. The person will have less energy and needs to make changes in work and home life.

There will be a number of activities and responsibilities which he or she will not be able to perform as much as before. Certain parts of the body may bloat a bit due to oedema (fluid retention), which may be relieved only after dialysis.

What is dialysis?When we consume food, our body takes what is needed for energy and self-repair, sending waste products to the blood. These waste products, together with the normal breakdown by-products of active tissues, are filtered in our kidneys by tiny units called nephrons.

Here, a complicated chemical exchange will take place, resulting in waste materials and water leaving our body via the urinary system. SO, when our nephrons are damaged, they lose their filtering capacity.

Dialysis treatment does some of the work of damaged kidneys, which includes the normal functions of removing excess water and waste products from the blood and restoring electrolyte levels.

Dialysis is the only treatment option available other than kidney transplantation for failed kidneys.

Types of dialysisThere are two types of dialysis treatment, namely haemodiaIysis and peritoneal dialysis.In haemodialysis, you will need to have a procedure to enable tubes to be inserted into your arm to send blood to a filter that removes waste products, which will return clean blood to your body.

Haemodialysis is done three times per week in a dialysis centre.

For peritoneal dialysis, a catheter tube is placed in your abdomen and fluid is put into your abdomen. This fluid will collect waste products from your blood.

After a few hours, the fluid which now contains your body's wastes is drained away and replaced with fresh new fluids in the abdomen. This dialysis can be done by the patients themselves at the comfort of their own homes about four to six times a day.

Effects of damaged kidneys"When the kidneys are damaged, it is no longer effective in performing important functions such as regulating blood pressure and red blood cell production. Therefore, patients with end-stage kidney failure must still watch their diet and fluid intake," says NKF Vice-Chairman Prof Datuk Dr Zaki Morad Mnhamad Zaher.

He adds: "Nevertheless, there are still risks and side effects to dialysis and it is important for patients to report these."

Side effects include sleep disorder, dry skin, cramps, nausea, vomiting, headaches, infections, bleeding from the access point of the tube for dialysis and sudden drop in blood pressure (hypotension) due to stress to the cardiovascular system.

After five years of dialysis, patients may contract dialysis-related amyloidosis (DRA), when protein from the blood is deposited onto the joints and tendons.

A dialysis patient may also contract hepatitis B due to their blood being exposed during the dialysis.

A condition known as anaemia, due to a reduced level of the hormone erythropnietin (EPO), which stimulates the bone marrow to produce red blood cells, may also occur.

To assist patients with these two conditions, NKF provides hepatitis B vaccination at cost and EPO medication for those who qualify free of charge to initiate the treatment and at cost subsequently.

Costly treatmentA patient has to go for dialysis three times per week, which means about 13 times per mouth. Each dialysis costs around RM250 at private hospitals. This will amount to about RM3,250 per month.

NKF patients who qualify for subsidy need only pay RM50 per treatment, amounting to RM650 permonth. The remaining cost is borne by the Ministry of Health Malaysia and NKF.

NKF currently has 20 dialysis centres and more than 1,000 dialysis patients to support nationwide. NKF spends an estimated total of RM3.5 million annually in dialysis treatment alone, not including other costs involved in providing medication and social welfare support for the needy kidney patients.

"NKF spends a lot on subsidies for dialysis and our commitment grow with the increasing number of new patients who come to us every year Clearly, we depend Ileavily on sponsorships and donations to fund our work. We need corporations and individuals to step up and show that they care," says Dr SS Gill, Chairman of the Board of Managers of NKF.

"In order for us to avoid endstage kidney failure and dialysis as well as the side effects relating to the disease, we should ensure a healthy lifestyle - healthy eating, exercising and maintaining a healthy body weight.

"We should not think that just because there is dialysis if our kid neys failed, we could wait until tha stage. By then, it will be too late.

"NKF under its Kidney Care programme aims to educate the peopl on the importance of their kidneys says Dr Goh Bak Leong, consultant nephrologist and Member of the NKF Board of Managers.

Optimistic about lungs - Nihilistic no more about lung cancer

Nihilistic no more about lung cancer-treating the lung cancer patient optimally and effectively

WE approached the patient with advanced lung cancer nihilistically until about 10 years ago. Back in the sad old days, the patient was largely given what was euphemistically called "best supportive care".

Often, all that meant was paiukillers and a comforting hug.

Today, the situation is quite different, Buoyed by the positive effects oftbe anti-cancer agent, cisplatiuum, 20 years ago, many clinical trials were launched to search for new cancer drugs or new combinations of drugs.

Today, patients with advanced lung cancer live longer and live better. This is all thanks to the scientific endeavour of researchers and clinicians working in cooperation and in concert with pharmaceutical companies.

But first, a word about early lung cancer. "Early" lung cancer implies that cure is a realistic goal.

Unfortunately, only about 10% of lung cancer can be considered early. Staging is all-important. To stage is to determine the extent of the cancer in the lung and whether it has spread to a distant site.

The PET/Whole Body CT Scan is indispensable in distinguishing early from advanced lung cancer. When there is doubt even with a sophisticated tool like PET/Whole Body CT, we can use an ultrasound guided technique via the trachea (windpipe) or oesophagus (food pipe) to sample any suspicious lymph node lying deep inside the chest. If the lymph node is involved with cancer, surgery is out.

The patient with lung cancer can then be assigned one of the following stages: 1, II, IIIA, IIIB and IV. For Stages l & II, the treatment is surgery followed by chemotherapy. For Stages Ilia & early IIIB, it is a combination of chemotherapy and radiotherapy.

Unfortunately, 90% of lung cancer patients will be found to have Stage IIIB or Stage IV disease i,e, what we call advanced lung cancer. This is the group of patients where there are many stirrings of new effective treatments. This is the group of patients which this article is all about. Three sets of drugs are routinely used to treat advanced lung cancer namely 1. The monoclonal antibodies, bevacizumab (Avastin) and cetuximab (Erbitux) 2. The tyrusine kinase inhibitors, gefitinib (lressa) and erlotinib (Tarceva) 3. Conventional cytotoxic agents e.g. cisplatinum, carboplatin, docetaxel, paclitaxel,gemcitabine, vinorelbine, pemetrexed It is good to have so many drugs and so many combinations of drugs. Patients with advanced lung cancer come in differentshapes and sniffles. They have different expectations and pockets.

Some are fit and can withstand a more robust treatment, for example, a combinations of two or three drugs.

Other patients may be less well and only one drug should be used.

And to each patient, I say "We have something to prolong your life and something to give your life quality."

Today, that comforting hug becomes an encouraging embrace. When patients don't do well with first-line treatment (the first set of anti-cancer agents employed) they can often be given effective second-line treatment.

There is even talk of third-line treatment.

Until the day comes when all advanced lung cancer patients can be cured, surely these patients deserve the best that science can offer today.

With the current therapies, patients with advanced lung cancer live, on the average, 12 months instead of eight.

Put another way, 50% of these patients will live a year if they are treated with current protocols instead of a paltry 20% two decades ago. There is always that 5% of patients wholive over three years having undergone two to three optimal lines of chemotherapy.

I write this essay not to announce "Lung Cancer Can Now Be Cured". Of course advanced lung cancer cannot be cured,

My point is that we have moved from therapeutic nihilism to therapeutic enthusiasm. And I believe that this is an important

Rubicon that we have crossed.

I end this essay with a reality check. We turn to pseudoscience (e.g. scalar energy), alternative medicine (qigong) and early Phase I trials (Cytotron) because we fear death.

Nothing is quite so simple and stark as that. But we have to accept that we cannot cure all cancers yet.

And your best bet of staying alive longer and more comfortably is still evidence-based and science-based medicine,

"All of us, among the ruins, are preparing a renaissance beyond the limits of nihilism. But few of us know it."